Under a previous contract, Health Accounting was shown to be a feasible and practical method by which patient health outcomes could be used to assess the quality of care. In the grant (1 R01 HS 01590-01), it has been proposed to evaluate the reliability and validity of the central procedures of the Health Accounting method, to document the patient health impact, and to evaluate the organizational impact. Ten clinics which have previously utilized Health Accounting methods will each undertake a series of three Health Accounting studies. The study subject priorities and the health outcome standards set by the clinic staff using formal small group estimation techniques will be statistically measured for reliability and validity. The ability of the paramedical Health Accountant to accurately determine the patient's function impairment level will be measured. As an implicit part of completing the Health Accounting project through the five stages of 1) Priority Setting, 2) Initial Outcome Assessment, 3) Definitive Assessment, 4) Improvement Action, and 5) Outcome Reassessment, the impact of Health Accounting on quality of care will be documented. A multiple time-series experimental design will be used to evaluate the organizational impact of the Health Accounting program. Organizational data will be gathered from documents and key respondents. Experimental and control clinics will be matched on the basic criterion of innovativeness rather than by randomization. Indicators for the measurement of innovativeness and the dependent variable, organizational change, will be specified. Construction of multiple item scales, confounding experimental effects, and issues in reliability and validity of concept measurement are important parts of the design.